Foetal Pain and Humanitarianism

Abortions are often performed to prevent suffering, and can certainly cause suffering, both mental and physical, for the woman. But can an abortion also cause suffering for the foetus and if so, at what stage in pregnancy? And what moral significance might this have?

In a recent paper in the Journal of Medical Ethics, the authors conclude that in the light of recent neuroscientific data they “no longer view fetal pain (as a core, immediate sensation) in a gestational window of 12–24 weeks as impossible based on the neuroscience”. The lead author, Professor Stuart Derbyshire, a psychologist, was a member of the Working Party of the Royal College of Obstetricians and Gynaecologists which put out a widely-quoted report in 2010 stating that “The experience of pain needs cognitive, sensory and affective components, as well as the necessary anatomical and physiological neural connections.” The report concluded that the unborn can only experience pain after twenty-four weeks, but that in any case, analgesics for the foetus are, on balance, not even to be recommended after that point.

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Derbyshire now rejects such views, recommending analgesics be considered much earlier, “especially after 18 weeks”. In the light of new data, the (pro-choice) Derbyshire and his (pro-life) co-author write:

we propose that the fetus experiences a pain that just is and it is because it is, there is no further comprehension of the experience, only an immediate apprehension. The fetus experiences something that is inherent to a certain level of biological activity, and which emerges at an unknown time often speculated to be after 12 weeks’ gestation … It can be argued that such a pain lacks a moral relevance, but we view that position with some suspicion. We may doubt whether the fetus (or an animal) ever feels anything akin to pain, but acting as if we have certainty flirts with a moral recklessness that we are motivated to avoid.

Tellingly, a spokeswoman for Britain’s leading “abortion provider”, BPAS, reacted by stating, “The most comprehensive review of this issue to date concluded a foetus cannot experience pain before 24 weeks.” This was, however, the very study Derbyshire was himself involved with, and whose findings he is now giving reasons for rejecting.

Scientific debate aside, why should BPAS (or Planned Parenthood) care about foetal pain in any case? If they are true to their stated beliefs about absolute autonomy for the pregnant woman, there is no intrinsic reason why they shouldn’t allow for abortions, even at nine months, not just without analgesia, but even as part of a deliberate experiment on foetal pain. To quote Ann Furedi, the head of BPAS, “You can’t be pro-choice except when you don’t like the choice, because that’s not pro-choice at all.”

For their part, pro-lifers should not, however, fall into the trap of recommending analgesia for unborn children about to be aborted, for this would amount to telling abortionists how to carry out abortions. If abortion is understood to be always morally wrong, then we cannot recommend to anyone how to carry it out (compare recommending to a child rapist that he use a condom, or indeed interact with the child online instead). At most, we can only tell abortionists how abortions must not be carried out.

In our society, considerations of foetal pain are more likely to gain a purchase on some people’s minds than considerations of the inherent worth of the existing early human being in the special domain of the mother’s womb. For while the humane killing of sentient non-human animals can be justified for sufficient reasons, when it comes to Homo sapiens, the human being’s possession of a nature oriented to rational thought and chosen pursuit of the true and the good means his life is good in a quite distinct way. Punishment or self-defence might conceivably justify killing a human as an adult, but such reasons are not at all the kinds of reasons normally used to justify killing a foetus—for example, the careers, health or relationships of others or their views on the “quality” of the life the individual has. 

Friedrich Nietzsche wrote in Beyond Good and Evil:

Whether it be hedonism, pessimism, utilitarianism, or eudaemonism, all those modes of thinking which measure the worth of things according to pleasure and pain, that is, according to accompanying circumstances and secondary considerations, are plausible modes of thought and naivetes, which everyone conscious of creative powers and an artist’s conscience will look down upon with scorn, though not without sympathy.

The statement is striking and largely true, although the eudaemonist Aristotle was always clear that pleasure and pain are properly assessed by the virtuous man, and that what is good and evil is not measured simply in terms of pleasure and pain. Just as we can have good or bad desires, so there can be good and bad pleasures. We can certainly “take pleasure” in things that are worthless or indeed, morally evil.

Yet in contemporary bioethics we still have voices that like of Peter Singer, who holds that pleasure maximisation and pain minimisation should be the ultimate criteria by which we should judge moral acts. Singer’s hedonistic utilitarianism, in his words, “eliminates the direct significance of the distinction between persons—defined as self-conscious beings who are aware of their existence over time—and sentient beings who are not persons”. Singer in any case rejects John Stuart Mill’s distinction between higher and lower pleasures: as he tells us, “I think that all pleasures are equal.”

Although Singer’s baldly presented view might not be shared by many in its entirety, many do see suffering or pain as the pre-eminent evil to be avoided (as opposed to human vice), and may also be doubtful that any well-motivated actions can nonetheless be intrinsically evil.

This outlook is prevalent in the kind of “humanitarianism” that characterises our age. “Relief of suffering” becomes the justification for all manner of actions which once would have been considered depraved. In medical ethics, Hippocratic warnings against abortion and euthanasia are set aside: these are no longer regarded as acts which are paradigmatically opposed to the healing goals of medicine. “Wrongful life” cases take hold, where certain lives are claimed, often by parents struggling to meet health care costs, to be better off not existing. Suicide becomes a “viable option”, if not an inevitable result in the context of a therapeutic culture combined with a bureaucratic and monistic calculus. Wars which fail to fulfil just-war criteria are justified on “humanitarian” grounds instead. Sexual ethics is emptied of its meaning, for it may be hard to demonstrate at least any short-term suffering involved in consensual sex, and the axiology of sex becomes hard to account for.

Aurel Kolnai realised what was happening to our culture decades ago when he noted:

The category of good and evil—of virtue and vice—being, as it were, mystically up-rooted here, a process of shrinking and flattening will blight the moral life in its entirety, including even its most directly “justifiable” and “useful” manifestations.

The very project of assigning pleasure and pain disproportionate roles in moral thinking is part of a package which takes a person’s urges as reasons for action just as such. But simply satisfying an urge does not guarantee the reasonableness of any action, and nor does satisfying many such urges of many people, in a bid to maximise satisfaction of desire.

One very human urge is the impulse to defend our own actions, precisely because our guilt for them may be so painful. But guilt is not always bad: a society that tried to eradicate rather than process any guilt for past actions would be taking a very dark path indeed. This unpleasant emotion has an important function in the moral life, and simply to assume that its minimisation is desirable in and of itself would be to fail to do moral philosophy at all. Here again, a simple-minded effort to reduce suffering would be utterly misguided.

A book called Our Heartbreaking Choices (2008) aptly demonstrates how a distortion of the place of suffering in moral thinking can occur in the face of deeply distressing circumstances surrounding pregnancy and foetal anomaly. The “heartbreaking choices” referred to are abortions of often seriously disabled unborn children. The justificatory reasoning for the abortions is variously expressed in the book as follows:

We are moms who loved our precious babies enough to let them go far sooner than we ever wanted to. We took on the possibility of a lifetime of emotional pain so that our little ones would not have to feel one moment of physical pain …

If you question their decision, you may come to understand that these parents bravely and unselfishly entered the suffering of grief in order that their babies be spared another kind of suffering …

We didn’t want Madison to suffer for even one second …

Here a simple weighing of sufferings—emotional pain versus physical pain—is run alongside extraordinarily exaggerated statements to the effect that even the slightest moment of physical pain may be avoided, even if this means taking the life of a loved child. And while the reality of pain in its different forms should not be underestimated (doctors and others rightly seek to relieve much of it), we are very far here from a reasonable picture of the role pain and suffering should play in the moral life.

In many cases the mother sees her grief (and perhaps other feelings) as involving more suffering than the possible pain, perhaps very short-lived, that the disabled child would feel after birth, and in this she may well be right. So in one obvious sense suffering in the world is increased by these actions. But it is nonetheless suggested that the suffering taken on by the parents, as opposed to the pain the child might have had, for however short a time, is somehow a valuable or noble burden to take on, as a necessary cost of bringing forward the child’s death.

Something is not right here. For what seems apparent is that these mothers, while they may desire only the best for their children and hope to be reunited with them in heaven, have failed to appreciate the fundamental value inherent in the child’s very existence. Indeed, without some sense of the intrinsic value of the unborn child it is difficult to see why so much importance should be assigned to his or her pain and suffering. For surely that importance, exaggerated as it is, derives in some way from the importance of the existence of the bearer?

Harsh as this sounds, and with all due acknowledgment of the intensity of the emotions involved, we seem again to be in the realm of sentimentality—an approach to emotion which, in the words of Malcolm Budd, involves the neglect of aspects of a situation that:

would necessitate a more complex and less rewarding response; a false intensity of experience is gained by ignoring any features that militate against the simple one-sided response, which typically idealizes, glamorizes and romanticizes the target, making it tug at the heartstrings.

The appreciation of the very existence of the human being is what is missing in the emotions of the mother. The preparedness to destroy the locus of value that is the human being betokens how distorted is a mother’s love which seeks to “benefit” the child, looks forward to reunion with him or her but fails adequately to appreciate the very being that the child is. One mother tells her baby, “How selfishly I wish for those moments of holding you in my arms, feeling your warmth, your movements outside my body. But I could not bear to think of you suffering.”

Such tragic valuations of the lives of the disabled and the terminally ill are deeply skewed and very much at odds with the experience of many disabled people. A fatal (and socially endorsed) sentimentality here leads to the destruction of values which call rather for complete (and socially supported) love for a fellow human being, including generous if sorrowing appreciation.

Dr Anthony McCarthy is an ethicist based in London at the Society for the Protection of Unborn Children. He holds degrees in philosophy from King’s College London, University College London and the University of Surrey, and is the author of Ethical Sex (2016) and Abortion Matters (2018).